Chapter 25 - Arthritides of the Hand and Wrist Flashcards
Joints affected in arthritis of the hand
DIP > Thumb CMC > PIP > MCP
Best XR for thumb CMC arthritis
thumb hyperpronated with the dorsal thumb MC flat of the cassette
DMARDs act on which pathways?
TNF a, or IL-I
what is the most common extraarticular manifestation of RA
subcutaneous nodules (25% of patients)
Which specialist should patients with JRA be referred to?
Ophthalmology - associated with uveitis
Most susceptible tendons to injury in RA?
EDQ and EDC
Wrist deformity in RA patients
supination, palmar dislocation, radial deviation, ulnar translocation of the carpus
treatment of extensor tendon injuries in RA
ECRL to ECU transfer corrects radial reviation and spination of the carpus
EIP to EDQ transfer or EDQ to EDC piggyback
Treatment of flexor tendon injuries in RA
FPL rupture - FDS transfer
FPL rupture with extensive joint disease - IP arthrodesis
FDS rupture - observe (FDS preserved)
FDP rupture - DIP fusion
Swan neck deformity
Hyperextension of the PIP, extensor lag at the DIP
Caused by attenuation of the volar plate, dorsal subluxation of the lateral bands, collateral ligament laxity
Boutonniere deformity
hyper flexion of the PIP with DIP hyperextension caused by PIP joint capsule weakening with subluxation of the lateral bands volarly and central slip attenuation
Common hand deformities in SLE
clinical deformity»_space; radiographic deformity. Dorsal subluxation of the ulna at the DRUJ is common - most often addressed with distal ulnar resection/arthrodesis
Soft tissue procedures at the MCPJ have high failure rate. deformity here best treted with arthroplasty or arthrodesis
What radiographic deformoity is pathognomonic for psoriatic arthritis?
Pencil in cup deformity of the PIP and DIP joints
